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A <br />ate:., {~7'/2a%0,$! <br />CORPORATE OFFICE: <br />801 Main Street <br />Vancd6ver, •WA 98660 <br />Tel: 360-816-8016. <br />• Toif Fr®~: 80Dj>~89=~'04~ ' <br />Fax: 360-816-8017 <br />Www albi ivr6rti, <br />~4=HOUR RESPON'St: <br />800635-5053 <br />t3i1't Ui Lading <br />VANCOUV9.R OPERATIONS- <br />1112 . West 7th Street, PO Box 788 <br />Vancouver, WA 98688 <br />Tel: 380418=8878 <br />Toll Free: .888-225-8237 <br />MADRAS: <br />400-.NW Piul4ass Way <br />Madras, OR 97741 <br />Tel: 641476.8836 <br />Ktt~KM;O►1F'Id-PAkI:S:,1;. • <br />x838 FiifKard°°Av~tiba; <br />;I9. th-F0Qs, QRra7603 <br />TQ~: ~1Tt3$Q•514>~ <br />Number: V[111297 <br />JOB NAME: LAME C[]UN-T- 11 <br />PW. <br />-DEPT OF <br />Customer <br />0.070844 <br />3040. DELTA <br />HWX <br />Des, ination t EUGENE <br />OR 97408 <br />.ist omen Name i <br />LANE. COUNTY , DEPT <br />OF PW <br />Addresst <br />3040 DELTA HWY <br />EUGENE <br />OR 97408 Cdntract <br />P. O. # <br />Loader Cade: <br />CA <br />W%S: 0021f-, Carrier <br />BEARCAT <br />,lobt: <br />962 <br />Trucks #t, <br />19 <br />:ALE •WSIGHTS <br />, _ <br />PRt t (1CT YNFORM' <br />Fi'l' ON <br />GrQ sa: <br />.36470.00 <br />Product Ha.m.e: <br />H-FR$f 1./HFF,g0IS <br />Tare: <br />13630. 00 <br />Net: <br />22840, 00 <br />atr for Net Tons: 22.84 <br />Load Tempt <br />190F/88C <br />English Tuna: 25.18 <br />Refiner Name: <br />AL.BINA A! PHALT <br />Net Liteca; <br />'22,424.034 <br />Refiner Loct <br />MADRAS <br />Met Gallons: <br />51 W3. 1PIla. <br />?r oaa•s Liters t <br />23, 244. 453 <br />Residue. % <br />-oee' Gallons-- <br />6,033,817 <br />flenetrati.on, 77 F. <br />Specific -Qra'vit~r: 0-.0000 <br />,11 <br />wader's Signature a <br />-ivef,'si SignAturL*: <br />a~tomer'a~ Signatur.et <br />Order Taken By <br />Customer Signature <br />A CERTIFICATION OF COMPLIANCE <br />maa•+sa~saxcrsccnsrssaccaz~aslmama:mac <br />I hearby oert,ify that the <br />asphaltic meteria.l identified <br />here meets all specifications <br />of the Oregon St. Hwy Delpt.- <br />CC~ ~ { 2~3 <br />This is to certify tttaY p y c1aisifled, described, <br />packaged, marked and labeled, and are in propel conditlont for transportation, <br />according to the applicable regulations of the Department of Transportation. <br />By: <br />Form F-350 REV. 07107 <br />